Vomiting And Diarrhea

Question 1

What are the stages of vomiting?

Answer 1

Nausea, Retching and Vomiting

Question 2

Signs of nausea

Answer 2

Reduced gastric tone
Duodenal and proximal jejunal tone increased
Depression, hyper-salivation, repeated swallowing
Duodenal contents into stomach

Question 3

Stages of vomiting

Answer 3

Glottis closed
Soft palate pressed against nasopharynx
Abdominal muscles and diaphragm contract
Cardia opens, pylorus contracts
Reverse peristalsis
Cardiac rhythm disturbed
Changes in colonic motility

Question 4

How do you tell the difference between regurgitation and vomiting?

Answer 4

Vomiting: abdominal effort, nausea, bile present, acidic pH, digested material, food if vomit quickly after eating

Regurgitating: effort from shoulders, food not digested, mucous present, cough

Question 5

What organs/ systems are involved in primary GI diseases?

Answer 5

Stomach, small intestines, and colon

Question 6

What organs/ systems/ factors are involved in secondary GI diseases?

Answer 6

Pancreas, kidney, liver, Primary CNS, electrolyte imbalances, toxins

Question 7

What diagnostic tools are most useful for primary GI disease?

Answer 7

Radiology, ultrasound, endoscopy

Question 8

What diagnostic tools are most useful for secondary GI disease?

Answer 8

Hematology, biochemistry, urinalysis, radiology, ultrasound, surgical exploration

Question 9

What are the signs that vomiting is due to a primary GI disease?

Answer 9

Vomiting with often relate in time to eating, delayed

Occur at variable times after eating in lower bowel disorders

Foreign body vomiting may occurs despite not eating

Palpable on physical exam

Paired with significant diarrhea

Vomit occurred then showed malaise, depression, anorexia

May be normal is all other aspects historically

Question 10

What the signs that Vomiting is due to a secondary GI disease?

Answer 10

Vomiting occurs subsequent to other signs, like depression/ inappetence

Other clinical signs present, like jaundice

Patients are usually metabolically ill

Question 11

Gastritis
Gastric foreign bodies
Gastric ulceration
Pyloric disorders
Abnormal motility
Enteritis
Intestinal obstruction
IBD
Neoplasia
Are all...

Answer 11

Common primary GI disease lesions

Question 12

The most common primary GI causes of vomiting are:

Answer 12

Gastritis
    Spoiled food, dietary indiscretion, food intolerance
Viral infection
    Parvovirus, corona, rota
Foreign body
GI neoplasm

Question 13

Most common causes of secondary GI vomiting?

Answer 13

Pancreatitis
Liver disease
Renal disease
Endocrine disease
   Diabetic ketoacidosis
  Hyperadrencorticism
  Hypercalcemia

Question 14

Cricopharyngeal disease
Hiatal hernia
Diverticula
Mega esophagus
Persistent right aortic arch
Mediastinal lymphoma
Thyroid tumors
Foreign body strictures
Esophagitis
Intramural lesions are all?

Answer 14

Lesions of esophageal disorders

Question 15

Break down the steps of the diagnostic approach to vomiting

Answer 15

Vomiting vs regurgitation

If vomit, primary or secondary, can’t tell

Investigate secondary or eliminate if appropriate
Identify organ, underlying disease

Investigate primary
Imaging, exploratory

Question 16

When is symptomatic therapy appropriate for vomiting?

Answer 16

Primary GI disease do to transient cause, toxin, or dietary indescretion

Question 17

This major presenting sign almost always indicates a primary GI lesion

Answer 17

Overt large bowel diarrhea, and mixed bowel diarrhea

Question 18

List the lesions of ACUTE small bowel diarrhea

Answer 18

Overeating
Dietary change
Spoiled food
Garbage
Parasites
Protozoa
Infection bacterial and viral

Question 19

List the primary and secondary lesions of CHRONIC small intestinal diarrhea

Answer 19

Secondary lesions
Toxins
Parasites
Diet intolerances, hypersensitivities
Bacteria and Protozoa
Deep mycoses
IBD aka Chronic Enteropathy
Neoplasia
Lymphangiectasia
Brush border enzyme defects

Secondary lesions
Hypoadrenocorticism
Hyperthyroidism (cats)
Exocrine pancreatic insufficiency( dogs) pancreatitis (chronic)

Question 20

Where do diet hypersensitivity skin lesions tend to appear in dogs vs cats?

Answer 20

Cats: ears and face

Dogs: auxiliary region and feet

Question 21

List the lesion of both acute and chronic large bowel diarrhea

Answer 21

Parasites
Protozoa
Bacteria
Diet related (toxin, fiber, intolerance, hypersensitivity)
Inflammatory (idiopathic, eosinophilic, granulomatous)
Neoplasia 
stress
Strictures

Question 22

List the diagnostic tools for chronic small and large bowel diarrhea

Answer 22

Fecal flotation and examination
Hematology and biochem ( secondary)
Fecal culture
Fecal panel
Serum trypsin like immunoreactivity ( TLI)
B12 and folate panels
Ultrasound
Biopsy

Question 23

When is it appropriate to biopsy?

Answer 23

Hypoproteinemia
Thicken intestinal wall or loss of layering
Significant weight loss
Hypercalcemia
Hypocobalaminemia
Neoplasia strongly suspected
O unable/ unwilling to follow diagnostic plan

Rule out parasites, dietary trials, secondary GI and treatment trial before considering

Question 24

List 3 factors that contribute to the seriousness of diarrhea in farm animals

Answer 24

Major Economic loss

Welfare

Environmental cost

Question 25

What pathogens are associated with acute diarrhea in calves? What age are calves most affected by each and the mortality rate?

Answer 25

E.coli- <5days- zoonotic, enterotoxigenic can cause death Cryptosporidia- 5-14 days- villus atrophy, often concurrent, Rotavirus- 7-14 days( max 3 weeks)- high morbidity low mortality Coronavirus-7-22 days- higher mortality Coccidia-> 3 weeks- poor growth rates, colitis Salmonella- all ages- always significant

Question 26

List the caused of acute and chronic diarrhea in adult cows

Answer 26

``` acute Salmonellosis Winter dysentery ( corona virus) Acidosis ( SARA) Malignant catarrhall fever Poison Mucosal disease BVD- RARELY ``` Chronic Johnes Ostertagiasis Fluke

Question 27

List the causes of acute and chronic diarrhea in lambs under 3 weeks

Answer 27

Acute Watery mouth Poor milk production ``` Chronic Rotavirus Corona virus E.coli Salmonella Lamb dysentery ```

Question 28

Most common causes of diarrhea in lambs 3-12 weeks old

Answer 28

Coccidiosis Nematodirosis - sudden death

Question 29

List the key factors to look into when investigating diarrhea on a farm?

Answer 29

``` Herd vs individual? Colostrum quality and time given Environment - cleaned regularly Regularly feeding (for calves) Vaccines Deworming Preventatives/ supplements ```

Question 30

Define Johnes Disease and list the key clinical signs, and solution

Answer 30

Is a chronic enteritis wasting diseases caused by MAP (Mycobacterium avium subspecies Paratuberculosis). Is zoonotic and is implicated in IBD and Crohns diseases in humans. Has no treatment Key signs Profuse hose type diarrhea Weight loss severe Solution All affected animals must be culled

Question 31

What are key steps to take to diagnose and control Johne’s Disease?

Answer 31

Prevent young animals from getting infected Do not house old and young animals Do not give infected colostrum Do not give pooled colostrum To diagnose Blood test ELISA ( low sensitivity, but high specificity ) Positive test is reliable

Question 32

What is the most common diarrhea in horses?

Answer 32

Primary GI, Secondary is very rare

Question 33

What are the most common causes of diarrhea in neonate foals?

Answer 33

``` Foal heat diarrhea Rotavirus Salmonella Clostridia Sepsis ```

Question 34

Most common causes of Diarrhea in older foals (10-12months)?

Answer 34

Proliferation enteropathy Rhodococcus equi colitis Parasitic diarrhea

Question 35

What are the most common causes of diarrhea in adult horses?

Answer 35

Salmonellosis Clostridium is Parasites Antimicrobial diarrhea Chronic IBD Undiagnosed NSAID toxicity should be noted

Question 36

Acute diarrhea in horses is a...

Answer 36

Life threatening medical emergency!!!

Question 37

Diarrhea is considered chronic when...

Answer 37

It as persisted for at least 2 weeks

Question 38

List the causes of acute diarrhea in horses?

Answer 38

``` Salmonellosis Parasitism ( cyanthostominosis, strongylosis) Clostridiosis Antimicrobial- associated diarrhea NSAID toxicity Sand enteropathy Carbohydrate overload ```

Question 39

List the causes of chronic diarrhea in horses

Answer 39

``` Salmonellosis Parasites Sand enteropathy NSAID toxicity IBD Abnormal fermentation Neoplasia Peritonitis Abdominal abscession ```

Question 40

What are the factors that predispose horses for diarrhea?

Answer 40

``` Young performance horses Antimicrobial or NSAID administration Stress Concurrent illness Recent deworming Exposure to other horses Poor foal hygiene ```

Question 41

What are the main diagnostic tools for equine diarrhea?

Answer 41

Fecal PCR Fecal Culture ELISA for viruses Mainly treat diarrhea supportively, try to find a diagnosis to rule out zoonoses

Question 42

When treating diarrhea in horses what are the main aspects we should address?

Answer 42

Prevention of spread Fluid and electrolyte therapy Control endotoxemia and sepsis Control enteric inflammation Re establish GI flora Specific Treatments

Question 43

What steps should be taken for biosecurity in horses with diarrhea?

Answer 43

Isolate Disinfect all personal equipment that comes in contact with affected animals PPE

Question 44

List the signs of dehydration and explain how it is measured?

Answer 44

Tachycardia, increased jugular refill time, pale mm, Increased CRT, decreased skin turgid, cool extremities, decreased urine output. <5% = clinically normal 8-10% = moderate, CRT 3-4 sec, hypovolemic signs >10%= severe >4-5sec, severe hypovolemic signs

Question 45

What type of fluids should be administered to horses and foals with diarrhea?

Answer 45

Polyionic fluids, hartmanns 10-20mls/kg horses 4-5mls/kg/hr in foals Administer bolus’ for shock

Question 46

Define endotoxemia and the clinical signs

Answer 46

Breakdown of physical barriers to endotoxins in intestine cause LPS to enter systemic circulation Clinical signs Fever,depression, pale mm, cold extremities, congested, toxic mm, prolonged CRT. ``` Advanced clinical signs Edema Tachycardia, low BP, prolonged CRT Lethargy, altered mentation Diarrhea Metabolic acidosis Thrombosis, and Petechial hemorrhages ```

Question 47

List the steps of endotoxemia treatment in horses

Answer 47

``` Remove the cause Neutralize the circulating LPS Inhibition of LPS induced Inflammation Modulate coagulation system Circulatory support ```

Question 48

Name the treatment for the following conditions Cyathostomiasis Clostridiosis Sand enteropathy Right coral enteropathy IBD.

Answer 48

Cyathostomiasis- moxidectin, dexamethasone, prednisolone Clostridiosis- metronidazole Sand enteropthy- psyllium mucilloid and magnesium sulfate Right dorsal colitis- misoprostal IBD- dexamethasone, prednisolone

Question 49

When doing a problem based approach to diarrhea in small animals what are the steps?

Answer 49

Define the: problem, location, system then lesion

Question 50

The most important tool in classifying the type of diarrhea present is what?

Answer 50

History

Question 51

How do you approach acute vs chronic diarrhea?

Answer 51

Acute: treat symptomatically Chronic: investigate fully

Question 52

List the characteristics of small bowel diarrhea

Answer 52

``` Consistency:Cow pie to watery Pattern: large volume and normal frequency Blood: not bright or fresh Color: ranges Weight loss if chronic Dehydration/pd Physical exam often unremarkable ```

Question 53

What are the characteristics of large bowel diarrhea?

Answer 53

``` Small amounts and often Mucous present Fresh blood on surface Tenesmus: straining No weight loss PE often unremarkable ```

Question 54

What are some of the secondary GI disorders that can cause small bowel diarrhea?

Answer 54

``` Hepatic disease Pancreatic insufficiency Pancreatitis Hyperthyroidism Hypoadrenocorticism ( Addison’s disease) Renal disease ```

Question 55

What does overt large bowel diarrhea as the major presenting signs almost always indicate?

Answer 55

A primary GI lesion

Question 56

Mixed bowel diarrhea as the major presenting sign usually is due to?

Answer 56

Primary GI disease

Question 57

Large bowel diarrhea associated with secondary GI disease usually...

Answer 57

Is not the presenting complaint, and has small bowel characteristics

Question 58

List the diet relates lesions that can cause acute small bowel diarrhea

Answer 58

Overeating Dietary changes Spoiled food Garbage

Question 59

List the parasites and Protozoa that can cause acute small bowel diarrhea

Answer 59

As raids Hookworms Giardia Coccidia

Question 60

List the viral and bacterial lesions that can cause acute small bowel diarrhea

Answer 60

Viral Parvovirus Coronavirus Rotavirus ``` Bacteria Campylobacter Salmonella Clostridium E.coli ```

Question 61

What are the possible primary GI lesions of chronic small bowel diarrhea?

Answer 61

``` Toxins Parasites Diet intolerances Diet hypersensitivity Bacteria and Protozoa Deep mycoses Chronic Enteropathy ( IBD) Neoplasm ```

Question 62

What are the possible secondary GI lesions of chronic small bowel diarrhea in small animals?

Answer 62

``` Hypoadrenocorticism Hyperthyroidism Exocrine pancreatic insufficiency Chronic pancreatitis Liver disease ```

Question 63

List the possible primary lesions of acute and chronic large bowel diarrhea

Answer 63

``` Parasites Trichuris culpis Anclostoma caninum Protozoa Giardia Entamoeba sp Tritrichomonas Bacteria Campylobacter, clostridium, salmonella, granulomatous collision Diet related Inflammatory Neoplasia Stress Stricture ```

Question 64

List the possible diagnostic tools for working up diarrhea

Answer 64

``` Fecal flotation Fecal examination Fecal culture/ panels Ultrasound Serum trypsin like immunoreactivity (TLI) Biopsy( rule out secondary before doing) B12 and folate to determine if supplements are needed Proper dietary trial ```